In November 2022, Central and North West London NHS Foundation Trust (CNWL) opened a Mental Health Crisis Assessment Service (MHCAS) at St Charles Hospital to provide a therapeutic alternative to attending Accident and Emergency (A&E) for those experiencing a Mental Health (MH) crisis.
The team assess anyone over 18 years old who would otherwise go to an emergency department for mental health reasons but who do not have an urgent medical need (for example, an overdose of medication).
Following their one-year anniversary, we spoke to Lewis Webster, Service Manager, about what the MHCAS team has achieved so far and what it offers patients today.
Since opening, MHCAS has seen 1,184 patients. Less than 15% of attendees are referred on to inpatient settings and over 85% are referred on to community alternatives closer to home. MHCAS has also succeeded in reducing the number of people admitted to an inpatient ward for less than seven days.
Located at St Charles Hospital, MHCAS treats patients in a calm, low-stimulus environment. Lewis says: “upon arrival, patients are greeted and offered a refreshment. Within half an hour, most patients will have a full bio-psychosocial assessment initiated so they don’t have to experience the same waiting times as they might in A&E.”
Skilled healthcare workers are on-hand to provide distraction activities like board games, television and colouring and maintain a relaxing and therapeutic space with accessible and visible clinicians. The environment is also less restrictive than a ward, giving patients more freedom to get some fresh air whenever they want.
MHCAS patients have the opportunity to rest in their own bedroom. Most people stay for approximately12 to 24 hours but there are cases where people might benefit from a longer stay if this will help them to avoid an inpatient admission.
You can read more about a patient’s experience of MHCAS here.
The team offer full emergency mental health assessments and onward care planning in the department with a diverse and highly skilled mental health workforce incorporating nurses, doctors and support workers.
Many MHCAS patients experience complex social issues, including issues with medication or housing – people who are sleeping rough have often been referred.
Lewis said “the team are responsive to each individual’s needs. They can link in with various community teams including Local Housing, CNWL’s Home Treatment Team and British Red Cross, if someone requires support with housing or care in the community. They can review a patient’s medication and make changes if necessary and may, in certain circumstances, advice that a patient might be better served on a ward where they have access to occupational therapy.”
A recent patient said:
"I recently attended MHCAS in October 2023, I had repeatedly attended numerous A&E departments across London in mental health crisis and partly because I couldn’t access housing. I was also repeatedly dismissed / discharged by the A&E’s until eventually I was transferred to MHCAS from St. Mary’s Hospital. The MHCAS staff were so caring and supportive. They were able to link me in with local mental health services and housing contacts. They also started me on an antidepressant that has since really improved my mood and better equipment to cope and manage the challenges I face."
In October 2023, the team recruited staff from British Red Cross who work operationally within the MHCAS setting. They are now recruiting for a psychologist.
MHCAS will continue to operate 24 hours a day, seven days a week, all through the winter period.